Teething typically begins around six months of age, though the timing varies widely, and its real symptoms are milder than most parents expect. The signs with the strongest evidence behind them are swollen gums, increased biting and drooling, and general crankiness. High fever, diarrhea, and serious illness are not caused by teething, and blaming them on a new tooth can delay treatment of an actual infection. The remedies with the best track record are also the simplest: chilled teething rings, gentle gum massage, and cuddles.
What Teething Actually Looks Like
A large meta-analysis pooling data from over 3,500 children between birth and 36 months found that roughly 70% of babies showed at least some signs or symptoms during tooth eruption. The three most common were gum irritation (about 87% of symptomatic children), irritability (about 68%), and drooling (about 56%).1Pediatrics. Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis A prospective study that tracked individual tooth eruptions confirmed a similar picture: increased biting, gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, facial rash, decreased appetite for solid foods, and a slight rise in temperature were all statistically associated with teething episodes.2PubMed. Symptoms associated with infant teething: a prospective study
The key word in that list is “slight” when it comes to temperature. A baby cutting a tooth may feel a bit warmer than usual, but teething does not cause a true fever. There is no credible evidence linking teething to high fever or gastrointestinal disturbances like diarrhea.3Journal of Clinical Pediatric Dentistry. Teething in infants: a structured review of symptomatology, parental misconceptions, and evidence-based management A child who looks genuinely unwell with a temperature above 38 °C (about 100.4 °F) should be evaluated by a doctor rather than written off as “just teething.”4PubMed Central. Mothers’ false beliefs and myths associated with teething
It’s worth noting that most teething symptoms cluster in the day or two before a tooth breaks through the gum and the day it actually appears, then fade quickly. If irritability or other signs drag on for more than a few days, something else is probably going on. Babies between six and 24 months are catching frequent colds and viral infections, and the overlap with teething timing makes it easy to mix up the two.
When Teeth Come In
The standard sequence starts with the lower central incisors, the two bottom front teeth, followed by the upper central incisors, upper lateral incisors, lower lateral incisors, first molars, canines, and finally the second molars.5PubMed Central. Eruption Timing and Sequence of Primary Teeth in a Sample of Romanian Children Most children have all 20 baby teeth by their third birthday.
Timing, however, is surprisingly variable across populations. A systematic review and meta-analysis of global data found that the first lower central incisor appeared at around six months in North American children but as late as about 13.5 months in some Asian populations. The last tooth in the sequence, the second molar, erupted at roughly 20 months in European samples but closer to 29 months in South American ones.6PubMed. Global variations in eruption chronology of primary teeth: A systematic review and meta-analysis So if your baby doesn’t have a tooth at seven or eight months, there’s no reason to worry. Genetics, nutrition, and even birth weight all influence when teeth show up.
A very small number of babies are born with teeth already visible, called natal teeth, or develop them in the first month of life (neonatal teeth). Natal teeth are about three times more common than neonatal teeth, but both are uncommon. They sometimes need to be evaluated because they can irritate the tongue or interfere with feeding.7PubMed Central. Natal and neonatal teeth: an overview of the literature If your newborn has what looks like a tooth, mention it to your pediatrician, but it isn’t necessarily a sign of any underlying condition.
The Fever and Diarrhea Myth
Ask almost any grandparent and they’ll tell you teething causes fevers and loose stools. This belief is remarkably persistent across cultures, but the research doesn’t back it up. One cohort study that followed babies daily and had both parents and childcare staff independently log symptoms found an interesting split: parents reported loose stools during teething episodes, but the childcare workers observing the same children did not. Only the parent-reported loose stools showed a statistically significant association with tooth eruption.8Pediatrics. Teething and Tooth Eruption in Infants: A Cohort Study That pattern suggests expectation bias. Parents who believe teething causes diarrhea are more likely to notice and report it during teething, while neutral observers don’t see the same link.
The danger in attributing fever or diarrhea to teething is that it can delay diagnosis of infections like urinary tract infections, ear infections, or even meningitis. A structured review of the evidence put it plainly: high fevers in a child who looks unwell should never be blamed on teething, and the child should be seen by a physician.4PubMed Central. Mothers’ false beliefs and myths associated with teething Teething is annoying for babies, but it isn’t a disease.
Does Teething Actually Wreck Sleep?
Parents frequently report that teething nights are terrible nights. But when researchers tested this with objective data, using video-based sleep monitoring over multiple teething and non-teething nights in the same infants, they found no significant differences in any sleep metric between teething and non-teething nights. Over half of the parents in the study reported sleep disturbances during teething, but those subjective reports didn’t match what the cameras recorded.9PubMed. Does Teething Disrupt Infant Sleep? A Longitudinal Auto-Videosomnography Study
This doesn’t mean parents are imagining things. It’s more likely that when a baby is fussy during the day from gum discomfort, parents are primed to interpret any nighttime waking as teething-related, even though brief wakings are normal for all infants. Babies in this age range wake multiple times per night as part of normal sleep cycling. On a “teething night,” you’re paying closer attention, so you notice every stir. The practical takeaway: if your baby’s nighttime sleep suddenly deteriorates for more than a few days, teething probably isn’t the explanation, and it’s worth looking into other causes like illness, a growth spurt, or a schedule change.
Remedies That Work
The interventions with the best evidence are refreshingly low-tech. A clinical trial comparing several non-drug approaches found that teething rings produced the most favorable results in terms of time to symptom recovery and maternal satisfaction, followed by what the researchers called “cuddle therapy” (basically, extra holding and comforting) and direct gum rubbing with a clean finger or damp cloth.10PubMed Central. Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies A systematic review confirmed those findings, noting that teething rings were particularly effective for drooling, sleep difficulties, gum irritation, and crying.11Brazilian Oral Research. Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review
A few practical tips on using these approaches:
- Teething rings: Solid silicone rings can be refrigerated (not frozen) for a cooling effect. Avoid liquid-filled rings that could break. Also avoid tying a ring around your baby’s neck, which is a strangulation risk.
- Gum massage: Wash your hands and rub the swollen area firmly with a clean finger or a cold, damp washcloth. The counter-pressure seems to soothe the discomfort more than gentleness does.
- Comfort and distraction: Extra cuddling, a cold wet washcloth to gnaw on, or even a chilled spoon can help. Distraction works surprisingly well in babies: a change of scenery, a new toy, or some time outdoors often interrupts the fussiness cycle.
If you want to offer a pain reliever, infant acetaminophen (paracetamol) or ibuprofen (for babies six months and older) can help on a particularly rough day. Use the dose on the package appropriate for your baby’s weight, and don’t make it a nightly habit. Teething episodes are self-limiting and generally don’t need ongoing medication.
What to Avoid
Several products marketed for teething relief are either useless or actively dangerous. The evidence here is clear enough that pediatric and dental organizations have taken firm positions.
Benzocaine gels and sprays (sold under brand names like Orajel for babies) are a significant concern. In 2011, the U.S. Food and Drug Administration issued a safety communication about the risk of methemoglobinemia, a condition that reduces the blood’s ability to carry oxygen, associated with topical benzocaine products.12PubMed Central. Pediatric Exposures to Topical Benzocaine Preparations Reported to a Statewide Poison Control System The FDA subsequently asked manufacturers to stop selling benzocaine oral products intended for children under two. Some products remain on shelves, so it’s worth checking labels.
Lidocaine-based teething gels carry their own risks. Case reports have linked them to seizures, respiratory arrest, and death in infants and young children when applied too liberally or too frequently.13PubMed. Are teething gels safe or even necessary for our children? A review of the safety, efficacy and use of topical lidocaine teething gels The problem with any numbing gel in a baby’s mouth is that the baby can’t tell you how much was applied, drool washes it away quickly (prompting reapplication), and the gel can be swallowed and absorbed systemically. The margin between an effective dose and a toxic dose is narrow in small bodies.
Homeopathic teething tablets have also drawn FDA warnings after reports of adverse events, including seizures. Some products were found to contain inconsistent amounts of belladonna, a toxic plant extract. Amber teething necklaces, which claim to release a natural painkiller from the resin, have no evidence supporting that claim and present choking and strangulation hazards. The American Academy of Pediatrics advises against both.
Even among pharmacists, there’s a knowledge gap. A survey found that while about half of pharmacists would appropriately recommend a non-drug option first and then an over-the-counter medication only if needed, a majority would still inappropriately select a benzocaine-containing product as their recommendation.14PubMed Central. What are pharmacists recommending for infant teething treatment? This means you can’t always rely on the person behind the pharmacy counter to steer you toward the safest option. When in doubt, stick with the non-drug remedies described above and ask your pediatrician before applying anything medicated to your baby’s gums.
Drool Rash and Skin Irritation
One of the more annoying side effects of teething isn’t in the mouth at all. The flood of drool that accompanies teething can irritate the skin around the mouth, chin, and neck, creating a red, bumpy rash sometimes called drool rash. It’s technically a form of irritant contact dermatitis: saliva is slightly acidic and contains digestive enzymes, and when it sits on skin for hours, it breaks down the skin barrier.
Managing drool rash is straightforward. Gently pat (don’t rub) the area dry throughout the day. Apply a thin layer of petroleum jelly or a fragrance-free barrier cream like one containing zinc oxide before naps and bedtime. This creates a physical shield between saliva and skin. Avoid scented wipes on the area since the fragrance can make irritation worse. If the rash becomes cracked, weepy, or doesn’t improve after a few days of barrier cream, have your pediatrician take a look. Occasionally what appears to be drool rash is actually a yeast infection or eczema flare that needs a different treatment.
Bibs can help during the day by absorbing drool before it pools against the skin, but remove them before sleep to avoid entanglement. Changing bibs frequently works better than letting one get soaked through.
Caring for New Teeth
Once a tooth breaks through, it can start decaying. The American Academy of Pediatrics recommends beginning fluoride toothpaste with the very first tooth. For children under three, use a smear about the size of a grain of rice, which delivers roughly 0.1 milligrams of fluoride. After age three, when a child can spit more reliably, increase to a pea-sized amount.15Pediatrics. Fluoride Use in Caries Prevention in the Primary Care Setting
Brush twice daily with a soft-bristled infant toothbrush. At this stage, you’re doing all the brushing; the baby is just getting used to the routine. Many parents skip the fluoride because they worry about their baby swallowing it, but the tiny amount in a rice-grain smear is well below any level of concern. The bigger risk is not using it and allowing early cavities, which are more common and more destructive in baby teeth than most people realize.
The first dental visit should happen by age one or within six months of the first tooth, whichever comes first. This visit is usually short and more about establishing a relationship with a dentist and catching any early problems than about a full cleaning.
Late Teethers and Early Teethers
Parents tend to compare milestones, and tooth eruption is no exception. Some babies have their first tooth at four months, and some don’t get one until after their first birthday. Both are within the range of normal. The global variation in eruption timing is substantial, with first-tooth averages spanning from about six months to over 13 months depending on the population studied.6PubMed. Global variations in eruption chronology of primary teeth: A systematic review and meta-analysis
Very early eruption (before three months) is uncommon and sometimes indicates natal or neonatal teeth, which may be part of the normal set or extra (supernumerary) teeth. A dentist can take an X-ray to figure out which. If the tooth is loose enough to be a choking hazard, or if it’s causing significant feeding problems or tongue ulceration, removal may be recommended.7PubMed Central. Natal and neonatal teeth: an overview of the literature If it’s stable and not causing issues, it’s usually left alone.
Very late eruption, meaning no teeth by 18 months, is worth mentioning to your pediatrician or dentist. In most cases there’s no underlying problem, and the teeth simply show up on their own timeline. Rarely, delayed eruption can be associated with nutritional deficiencies, hypothyroidism, or certain genetic conditions, so a check-up is sensible just to rule those out. Premature babies often teethe later when counted from their birth date, but the timing usually lines up better with their adjusted age.
Teething and Breastfeeding
Many nursing parents dread teething for one specific reason: biting. It does happen, but most babies bite during teething because their gums hurt and they’re looking for counter-pressure, not because they’re trying to be difficult. The good news is that a baby who is actively nursing with a proper latch physically can’t bite, because the tongue covers the lower teeth during sucking. Biting usually happens at the end of a feeding when the baby starts to lose interest or at the beginning before they’ve latched on fully.
If your baby bites, a calm but firm “no,” briefly taking them off the breast, and then relatching is usually enough to teach them that biting ends the meal. Offering a teething ring before a feed to take the edge off gum discomfort can reduce the urge to bite. Some parents find that chilled breast milk popsicles (frozen in mesh feeders) satisfy both the hunger and the teething need simultaneously.
Teething is not a reason to wean. The discomfort is temporary, and most babies continue nursing without any change in their pattern. If your baby seems to be refusing the breast during a teething episode, they may just be in pain. Trying different positions, offering the breast when the baby is sleepy and less aware of the discomfort, or giving a dose of infant pain reliever 20 to 30 minutes before nursing can help get through the rough patch.